Siebels M, Andrassy K, Waldherr R, Ritz E
Department of Internal Medicine, Ruperto Carola-University, Heidelberg, Germany.
Am J Kidney Dis. 1995 Feb;25(2):336-9. doi: 10.1016/0272-6386(95)90017-9.
Hemolytic uremic syndrome/thrombotic thrombocytopenic purpura is known to occur as a secondary complication of primary renal diseases, specifically of lupus nephritis, membranous glomerulonephritis, and focal segmental glomerulosclerosis. In a patient without a family history of hemolytic uremic syndrome/thrombotic thrombocytopenic purpura we observed biopsy-confirmed postinfectious glomerulonephritis with humps, with simultaneous subendothelial hyaline deposits and fibrinoid thrombi in arterioles. The patient had a history of febrile pharyngitis with diarrhea 10 days prior to renal biopsy. He presented with transient elevation of serum creatinine, a nephritic sediment, and hypertension not exceeding 160/100 mm Hg. The patient also had purpura, transient thrombocytopenia, and signs of intravascular hemolysis. Results of verocytotoxin serology were negative. With the exception of isolated microhematuria, all findings reverted to normal within 8 weeks without any specific treatment. This case illustrates that hemolytic uremic syndrome/thrombotic thrombocytopenic purpura may complicate primary postinfectious glomerulonephritis in adults.
溶血尿毒综合征/血栓性血小板减少性紫癜已知可作为原发性肾脏疾病的继发性并发症出现，特别是狼疮性肾炎、膜性肾小球肾炎和局灶节段性肾小球硬化症。在一名无溶血尿毒综合征/血栓性血小板减少性紫癜家族史的患者中，我们观察到经活检证实的伴有驼峰的感染后肾小球肾炎，同时在小动脉中有内皮下透明沉积物和纤维蛋白样血栓。该患者在肾活检前10天有发热性咽炎伴腹泻病史。他出现血清肌酐短暂升高、肾炎性沉渣以及不超过160/100 mmHg的高血压。患者还出现紫癜、短暂性血小板减少和血管内溶血迹象。产志贺毒素血清学结果为阴性。除孤立性镜下血尿外，所有检查结果在8周内未经任何特殊治疗即恢复正常。该病例表明，溶血尿毒综合征/血栓性血小板减少性紫癜可能使成人原发性感染后肾小球肾炎复杂化。
